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Pulmonary manifestations of adult-onset Still's disease (AOSD) include aseptic pneumonitis, pleural effusions, rarely acute respiratory distress syndrome, and restrictive lung disease. Pulmonary arterial hypertension (PAH) occurs with several rheumatologic diseases, however, has only been reported once in AOSD. We describe a 29-year-old woman with a 9-year history of AOSD, who developed PAH without any other obvious cause. Therefore, we conclude that this is likely a result of pulmonary vascular changes related to AOSD.

Sarcoidosis is a multisystem disease characterized by noncaseating granulomatous reaction frequently involving the lymph nodes, lungs, liver, skin, and eyes. Acute renal failure (ARF) as an isolated manifestation of sarcoidosis is rare. We describe a case of sarcoidosis presenting as transient polyarthritis and ARF due to isolated granulomatous infiltration of the renal parenchyma. Renal biopsy showed granulomatous interstitial nephritis with noncaseating granulomas consistent with sarcoidosis. Bacterial, fungal, and mycobacterial infections were excluded. There was no evidence of extrarenal sarcoid involvement. Prednisone of 60 mg daily resulted in significant improvement in renal function. Because of recurrent flares on steroid taper and steroid toxicity, treatment with infliximab, an anti-tumor necrosis factor-alpha (TNF-alpha) antibody, was instituted and resulted in stabilization of renal function despite steroid taper. Although uncommon, renal sarcoidosis should be considered in the differential diagnosis of acute or chronic renal failure of uncertain etiology, as early diagnosis and treatment can lead to recovery of renal function and prevent interstitial fibrosis. Corticosteroids are mainstay of therapy. Steroid-dependent or refractory cases may respond to other immunosuppressants including anti-TNF-alpha agents.

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Objectives: To determine the prevalence of type-2 diabetes mellitus (DM) in patients with hepatitis C virus (HCV) and B virus (HBV) infections. Materials and Methods: A cross-sectional study of HCV- and HBV-positive patients admitted to King Abdul Aziz University Hospital, Jeddah, Saudi Arabia, was conducted from January 1999 to September 2000. The following data were collected and analysed: demographic data, the presence and type of DM, details of the treatment, body mass index (BMI), family history of DM, serum transaminases, thrombocytopenia, and presence of liver cirrhosis on liver biopsy. A total of 399 patients were included in the study. Results: 165 (41%) were anti-HCV positive and 234 (59%) were HBsAg positive. Type-2 diabetes was present in 35 of 165 (21.2%) patients with HCV infection, and 33 of 234 (14.1%) with HBV infection. 94% of anti-HCV-positive type-2 diabetes were older than 40 years and 6% were younger, while for nondiabetics the corresponding percentages were 55 and 45%, respectively. 76% of HBsAg-positive type-2 diabetics were older than 40 and 24% were younger, while the corresponding percentages for nondiabetics were 27 and 73%, respectively. Anti-HCV-positive type-2 diabetics, when compared to nondiabetics, had a higher BMI, a frequent family history of DM, elevated serum transaminases, thrombocytopenia, and liver cirrhosis on biopsy. HBsAg-positive type-2 diabetics had only a more frequent family history of DM than did nondiabetics. Conclusion: Our findings indicate that type-2 diabetes is more common in patients with an HCV than with an HBV infection.